| NPI | 1447412127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 440460) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 003000) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: SC 440460) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-06-02 |